ortho

1. Rotator cuff disorders
Dr. Ihsan Alshamy
FIBMS Orth.

2. Anatomy of rotator cuff
Formed by tendons of 1. supraspinatus muscle 2. Infraspinatus muscle3.Subscapularis
muscle, the 3 tendons unite to form ( rotator cuff tendon) which pass beneath the
coracoacromial ligament, separated from it by Bursa and inserted in head of the
humerus. Function : initiation of abduction.

3. Rotator cuff
Deltoid
Scapula rotation on
the chest

4. pathology
Friction of the rotator cuff under the coracoclavicular ligament occurs in position when the
arm is abducted, slightly flexed and internally rotated ; this called ( impingement position),
like in cleaning windows
1

5. 2 Osteoarthritis of acromioclavicular joint with osteophytes

6. 3 Subacromial bursitis like in rheumatoid arthritis or Gout

7. Continuous friction may lead to :
tendinitis or partial tear or complete tear

8. Clinical features
Anterior shoulder pain after vigorous activity like swimming , window cleaning,
hair grooming

9. Examination for tendinitis
1- Painful arc test: anterior shoulder pain between 60-120 degree of shoulder
abduction, repeating the movement with arm in external rotation is much painless.

10. 2. Neers impingement test : flexion abduction internal rotation of the shoulder produce
anterior shoulder pain under the acromion process, repeating the maneuver after injection
of 10 ml of xylocaine ( local anesthesia) will greatly reduces the pain

11. Partial and complete tear
The same clinical features of tendinitis but the patient can Not initiates
active abduction of the arm; to differentiate between partial and
complete tear we inject 10 cc of local anesthesia ( xylocaine) in
Subacromial space, if the patient can do active abduction of the arm after
the injection means it is partial tear; and if he still can not do abduction it
means complete tear

12. Drop arm sign: singe of complete tear

13. X- ray
-Erosion of greater tuberosity
-Upward migration of humeral head
-Osteoarthritis of acromioclavicular joint

14. MRI
Best method of diagnosis. It shows the cuff tear

15. Ultrasound
May show cuff tear

16. Treatment
conservative treatment
Avoidance of impingement position
NSAI
Physiotherapy
Active exercise in position of freedom

17. If no response to conservative treatment
Subacromial injection of steroid

18. Surgery ( called acrmioplasty)
Indicated in full thickness tear
Surgery includes removal of the coracoacromial ligament, removal of
osteophytes from the under surface of acromion. It can be done open or
arthroscopic.

19. Biceps tendinitis

20. Biceps muscle has 2 heads of origin; short head from coracoid process and long head from
the glenoid margin, the muscle inserted in the radius bone below elbow, it is responsible
for elbow flexion and forearm supination

21. Biceps tendinitis usually occurs in the long head, either alone or in association
with rotator cuff syndrome

22. Diagnosis
1-Speed test: resisted flexion of the elbow with
forearm supinated produce anterior shoulder
pain.

23. 2-Yergason test: resisted supination of the elbow
with forearm flexion will produce anterior shoulder
pain.

24. Treatment
1. Conservative : local heat, NSAI, local injection
of steroid.
2. Surgery: include tendon decompression,
biceps tenotomy.

25. Rupture biceps muscle

26. may occurs in elderly after lifting heavy weight, characterized by bruises and
ecchymosis over the proximal arm

27. Resisted flexion of the elbow will produce lump (Popeye sign)

29. Treatment: in elderly usually conservative treatment. Young patient need
surgical repair of the tendon.